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Dombrowski C, Bourgain C, Ma Y, Meiwald A, Pinsent A, Weynand B, Turner KME, Huntington S, Adams EJ, Bogers J, Croes R, Sahebali S. An economic evaluation of two cervical screening algorithms in Belgium: HR-HPV primary compared to HR-HPV and liquid-based cytology co-testing. Eur J Cancer Prev 2024; 33:262-270. [PMID: 37933867 DOI: 10.1097/cej.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To assess the costs and benefits of two algorithms for cervical cancer screening in Belgium (1) high-risk human papillomavirus (HR-HPV) primary screening and (2) HR-HPV and liquid-based cytology (LBC) co-testing. METHODS A decision tree was adapted from published work and parameterised using HORIZON study data and Belgian cost and population data. The theoretical model represents two different screening algorithms for a cohort of 577 846 women aged 25-64 attending routine cervical screening. Scenario analyses were used to explore the impact of including vaccinated women and alternative pricing approaches. Uncertainty analyses were conducted. RESULTS The cost per woman screened was €113.50 for HR-HPV primary screening and €101.70 for co-testing, representing a total cost of €65 588 573 and €58 775 083, respectively, for the cohort; a 10% difference. For one screening cycle, compared to HR-HPV primary, co-testing resulted in 13 173 more colposcopies, 67 731 more HR-HPV tests and 477 020 more LBC tests. Co-testing identified 2351 more CIN2+ cases per year (27% more than HR-HPV primary) and 1602 more CIN3+ cases (24% more than HR-HPV primary) than HR-HPV primary. CONCLUSION In Belgium, a co-testing algorithm could increase cervical pre-cancer detection rates compared to HR-HPV primary. Co-testing would cost less than HR-HPV primary if the cost of the HPV test and LBC were cost-neutral compared to the current cost of LBC screening but would cost more if the cost per HPV test and LBC were the same in both co-testing and HR-HPV primary strategies.
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Affiliation(s)
| | - Claire Bourgain
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | - Yixuan Ma
- Aquarius Population Health, London, UK
| | | | | | - Birgit Weynand
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | | | | | | | - Johannes Bogers
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
- University of Antwerp, Laboratory for Cell Biology and Histology, Antwerp
| | | | - Shaira Sahebali
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
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Puri Sudhir K, Kagenaar E, Meijer M, Hesselink AT, Adams E, Turner KME, Huntington S. Comparing the Costs and Diagnostic Outcomes of Replacing Cytology with the QIAsure DNA Methylation Test as a Triage within HPV Primary Cervical Cancer Screening in The Netherlands. Diagnostics (Basel) 2023; 13:3612. [PMID: 38132196 PMCID: PMC10742725 DOI: 10.3390/diagnostics13243612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Detecting hypermethylation of tumour suppressor genes could provide an alternative to liquid-based cytology (LBC) triage within HPV primary cervical screening. The impact of using the QIAsure® FAM19A4/mir124-2 DNA Methylation Test (QIAGEN, N.V, Hilden, Germany) on CIN3+ diagnoses, retention, unnecessary colposcopies, and programme costs is unknown. A decision-tree model was developed to compare LBC with the QIAsure Methylation testing to guide colposcopy referral. Incorporating clinician- and self-sampling pathways the model was informed by the Dutch cervical cancer screening programme, published studies, and manufacturer data. Clinical and cost outcomes were assessed using two scenarios for DNA methylation testing and LBC relative performance. Sensitivity analyses (deterministic and probabilistic) were performed to assess model and parameter uncertainty. A range of self-sampling uptake was assessed in scenario analyses. For the screening cohort (n = 807,269) where 22.1% self-sampled, the number of unnecessary colposcopies and CIN3+ diagnoses varied according to the relative performance of methylation testing and LBC. Irrespective of relative performance, the cost per complete screen was lower and fewer people were lost to follow-up when using DNA methylation testing. The results indicate that, within an HPV primary screening programme that incorporates self-sampling, using the QIAsure Methylation Test for triage reduces the cost per screen compared to LBC.
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Affiliation(s)
| | - Eva Kagenaar
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
| | - Michelle Meijer
- Self-Screen B.V., Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
| | | | - Elisabeth Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
| | - Katy M. E. Turner
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
| | - Susie Huntington
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
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Miners L, Huntington S, Lee N, Turner KME, Adams E. Correction to: an economic evaluation of two PCR-based respiratory panel assays for patients admitted to hospital with community-acquired pneumonia (CAP) in the UK, France and Spain. BMC Pulm Med 2023; 23:296. [PMID: 37568141 PMCID: PMC10416480 DOI: 10.1186/s12890-023-02572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Lisa Miners
- Aquarius Population Health, Unit 29 Tileyard Studios, N7 9AH, London, UK
| | - Susie Huntington
- Aquarius Population Health, Unit 29 Tileyard Studios, N7 9AH, London, UK.
| | - Nathaniel Lee
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Katy M E Turner
- Aquarius Population Health, Unit 29 Tileyard Studios, N7 9AH, London, UK
| | - Elisabeth Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, N7 9AH, London, UK
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Miners L, Huntington S, Lee N, Turner KME, Adams E. An economic evaluation of two PCR-based respiratory panel assays for patients admitted to hospital with community-acquired pneumonia (CAP) in the UK, France and Spain. BMC Pulm Med 2023; 23:220. [PMID: 37344852 PMCID: PMC10283259 DOI: 10.1186/s12890-023-02516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND On admission to hospital, patients with community-acquired pneumonia (CAP), undergo extensive diagnostic testing. Two high-throughput laboratory-based PCR panels which return a result in 5.5 hours (h) have been developed to test for pathogens commonly associated with upper (Respiratory 1 Panel) and lower (Respiratory 3 Panel) respiratory tract infections (GeneFirst, Oxford). These could replace multiple diagnostic tests currently used. METHODS An online survey, completed by senior clinicians in the UK, France and Spain, was used to collect data on the diagnostic testing of immunocompetent and immunocompromised adults admitted to hospital with CAP, including the cost of diagnostics. Data were used to inform a cost-comparison model. For each country, the average cost of diagnostic testing per patient was calculated separately for immunocompetent and immunocompromised patients. The model compared three testing strategies with standard of care (SoC). In the Panel 1 strategy, the Respiratory 1 Panel was used for patients that would otherwise have tests which could be replaced by Respiratory 1 Panel, equivalent strategies for Respiratory 3 Panel and for both panels combined were assessed. RESULTS In total, 48 surveys were completed (UK = 17; France = 15; Spain = 16). Compared with SoC, the Panel 1 + 3 strategy was most favourable, resulting in cost savings for immunocompetent and immunocompromised patients respectively, of €22.09 (£18.50) and €26.12 (£21.88) in the UK, €99.60 and €108.77 in France and €27.07 and €51.87 in Spain. CONCLUSION In all three countries, the use of these respiratory panels could reduce the average cost of diagnostics used for patients admitted to hospital with CAP.
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Affiliation(s)
- Lisa Miners
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Susie Huntington
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK.
| | - Nathaniel Lee
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Katy M E Turner
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Elisabeth Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
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Huntington S, Puri Sudhir K, Schneider V, Sargent A, Turner K, Crosbie EJ, Adams EJ. Two self-sampling strategies for HPV primary cervical cancer screening compared with clinician-collected sampling: an economic evaluation. BMJ Open 2023; 13:e068940. [PMID: 37280031 DOI: 10.1136/bmjopen-2022-068940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To compare the costs and effects of three sampling strategies for human papillomavirus (HPV) primary screening. DESIGN Cost-consequence analysis from a health system perspective using a deterministic decision tree model. SETTING England. PARTICIPANTS A cohort of 10 000 women aged 25-65 years eligible for the National Health Service Cervical Screening Programme (NHSCSP). METHODS The model was based on the NHSCSP HPV primary screening pathway and adapted for self-sampling. It used a 3-year cycle: routine screening (year 1) and recall screening (years 2/3). Parameter inputs were informed using published studies, NHSCSP reports and input from experts and manufacturers. Costs were from 2020/2021, British pound sterling (£). INTERVENTIONS Three sampling strategies were implemented: (1) routine clinician-collected cervical sample, (2) self-collected first-void (FV) urine, (3) self-collected vaginal swab. The hypothetical self-sampling strategies involved mailing women a sampling kit. MAIN OUTCOME MEASURES Primary outcomes: overall costs (for all screening steps to colposcopy), number of complete screens and cost per complete screen. SECONDARY OUTCOMES number of women screened, number of women lost to follow-up, cost per colposcopy and total screening costs for a plausible range of uptake scenarios. RESULTS In the base case, the average cost per complete screen was £56.81 for clinician-collected cervical sampling, £38.57 for FV urine self-sampling and £40.37 for vaginal self-sampling. In deterministic sensitivity analysis, the variables most affecting the average cost per screen were the cost of sample collection for clinician-collected sampling and the cost of laboratory HPV testing for the self-sampling strategies. Scaled to consider routine screening in England, if uptake in non-attenders increased by 15% and 50% of current screeners converted to self-sampling, the NHSCSP would save £19.2 million (FV urine) or £16.5 million (vaginal) per year. CONCLUSION Self-sampling could provide a less costly alternative to clinician-collected sampling for routine HPV primary screening and offers opportunities to expand the reach of cervical screening to under-screened women.
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Affiliation(s)
| | | | | | - Alex Sargent
- Cytology Department, Clinical Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Ther Adv Infect Dis 2021; 8:20499361211061645. [PMID: 34881023 PMCID: PMC8647227 DOI: 10.1177/20499361211061645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient's visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.
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Huntington S, Weston G, Seedat F, Marshall J, Bailey H, Tebruegge M, Ahmed I, Turner K, Adams E. Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis. BMJ Open 2020; 10:e038505. [PMID: 33444184 PMCID: PMC7678359 DOI: 10.1136/bmjopen-2020-038505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women. DESIGN A decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results. SETTING UK antenatal screening programme. POPULATION Hypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses. RESULTS Base case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494. CONCLUSIONS Universal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.
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Affiliation(s)
| | | | - Farah Seedat
- UK National Screening Committee, Public Health England, London, UK
| | - John Marshall
- UK National Screening Committee, Public Health England, London, UK
| | - Heather Bailey
- UCL Institute for Global Health, University College London, London, UK
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
- Department of Paediatrics, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Katy Turner
- School of Veterinary Science, University of Bristol, Bristol, UK
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Kerry-Barnard S, Huntington S, Fleming C, Reid F, Sadiq ST, Drennan VM, Adams E, Oakeshott P. Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the 'Test n Treat' feasibility trial. BMC Health Serv Res 2020; 20:316. [PMID: 32299437 PMCID: PMC7160983 DOI: 10.1186/s12913-020-5062-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges. METHODS Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate). RESULTS The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected. CONCLUSIONS Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable. TRIAL REGISTRATION ISRCTN58038795, Assigned August 2016, registered prospectively.
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Affiliation(s)
- Sarah Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Susie Huntington
- Aquarius Population Health Limited, Unit 29, Tileyard Studios, Tileyard Rd, London, N7 9AH, UK.
| | - Charlotte Fleming
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, SE1 1UL, UK
| | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, SW17 ORE, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University and St George's University of London, London, SW17 ORE, UK
| | - Elisabeth Adams
- Aquarius Population Health Limited, Unit 29, Tileyard Studios, Tileyard Rd, London, N7 9AH, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK
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Stirrup OT, Sabin CA, Phillips AN, Williams I, Churchill D, Tostevin A, Hill T, Dunn DT, Asboe D, Pozniak A, Cane P, Chadwick D, Churchill D, Clark D, Collins S, Delpech V, Douthwaite S, Dunn D, Fearnhill E, Porter K, Tostevin A, Stirrup O, Fraser C, Geretti AM, Gunson R, Hale A, Hué S, Lazarus L, Leigh-Brown A, Mbisa T, Mackie N, Orkin C, Nastouli E, Pillay D, Phillips A, Sabin C, Smit E, Templeton K, Tilston P, Volz E, Williams I, Zhang H, Fairbrother K, Dawkins J, O’Shea S, Mullen J, Cox A, Tandy R, Fawcett T, Hopkins M, Booth C, Renwick L, Renwick L, Schmid ML, Payne B, Hubb J, Dustan S, Kirk S, Bradley-Stewart A, Hill T, Jose S, Thornton A, Huntington S, Glabay A, Shidfar S, Lynch J, Hand J, de Souza C, Perry N, Tilbury S, Youssef E, Gazzard B, Nelson M, Mabika T, Mandalia S, Anderson J, Munshi S, Post F, Adefisan A, Taylor C, Gleisner Z, Ibrahim F, Campbell L, Baillie K, Gilson R, Brima N, Ainsworth J, Schwenk A, Miller S, Wood C, Johnson M, Youle M, Lampe F, Smith C, Tsintas R, Chaloner C, Hutchinson S, Walsh J, Mackie N, Winston A, Weber J, Ramzan F, Carder M, Leen C, Wilson A, Morris S, Gompels M, Allan S, Palfreeman A, Lewszuk A, Kegg S, Faleye A, Ogunbiyi V, Mitchell S, Hay P, Kemble C, Martin F, Russell-Sharpe S, Gravely J, Allan S, Harte A, Tariq A, Spencer H, Jones R, Pritchard J, Cumming S, Atkinson C, Mital D, Edgell V, Allen J, Ustianowski A, Murphy C, Gunder I, Trevelion R, Babiker A. Associations between baseline characteristics, CD4 cell count response and virological failure on first-line efavirenz + tenofovir + emtricitabine for HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30037-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Zeidan A, Hu X, Long J, Wang R, Ma X, Podoltsev N, Huntington S, Gore S, Davidoff A. Hypomethylating Agent Therapy use and Survival in Older Patients with Chronic Myelomonocytic Leukemia in USA: A Large Population-Based Study. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Huntington S, Heppner J, Vohra R, Mallios R, Geller RJ. Serious adverse effects from single-use detergent sacs: report from a U.S. statewide poison control system. Clin Toxicol (Phila) 2014; 52:220-5. [PMID: 24580062 DOI: 10.3109/15563650.2014.892122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In recent years, serious adverse effects to children from exposure to single-use detergents sacs (SUDS) have been recognized. While most exposures result in minor symptoms, there have been serious outcomes. This study aims to classify which types of serious outcomes follow SUDS exposures, and to assess, if possible, differences in toxicity between various SUDS products. METHODS An observational case series with data collected retrospectively was performed for cases of SUDS exposures reported to a statewide poison system's records database from 1 January 2012 to 31 March 2013. Cases were identified and analyzed for clinical details and trends. A statewide database was queried for cases involving the American Association of Poison Control Centers (AAPCC) product-specific codes for SUDS products using following search terms: laundry pods, the AAPCC product-specific codes for Tide Pods, Purex Ultrapacks, ALL Mighty Pacs, and a unique agent code (AAPCC ID: 6903138; Generic: 077900) created by AAPCC to track SUDS exposures. RESULTS A total of 804 cases of exposures to SUDS were identified, the majority of which were exploratory ingestions in young children with a median age of 2 years. Serious adverse effects resulted from 65 (9%) exposures and 27 (3%) exposures resulted in admission to hospital. Binary logistic regression demonstrated that the presence of central nervous system (CNS) or respiratory system effects were associated with more severe outcomes, with a model accuracy of 96.4%. There were significant differences in morbidity among the three most common brand-name products: when compared with Tide Pods, odds ratios (OR) and 95% confidence intervals (CI) for severe outcome and admission rate were significantly greater following Purex Ultrapack exposures (severity OR 5.1 [CI: 2.13-12.23]; admission OR 10.36 [CI: 3.23-33.22]) and ALL Mighty Pac exposures (severity OR 11.22 [CI: 4.78-28.36]; admission OR 15.20 [CI: 5.01-46.12]). CONCLUSIONS Serious complications from exposure to SUDS occur in a small number of exposures for unclear reasons. Respiratory and CNS effects are associated with more severe outcomes. Some brand-name products are associated with a relatively higher risk of severe adverse effects and rates of admission.
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Affiliation(s)
- S Huntington
- California Poison Control System, Children's Hospital Central California , Madera, CA , USA
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Huntington S, Thorne C, Anderson J, Newell ML, Taylor GP, Pillay D, Hill T, Tookey P, Sabin C. Response to antiretroviral therapy (ART): comparing women with previous use of zidovudine monotherapy (ZDVm) in pregnancy with ART naïve women. BMC Infect Dis 2014; 14:127. [PMID: 24593018 PMCID: PMC3995971 DOI: 10.1186/1471-2334-14-127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Short-term zidovudine monotherapy (ZDVm) remains an option for some pregnant HIV-positive women not requiring treatment for their own health but may affect treatment responses once antiretroviral therapy (ART) is subsequently started. Methods Data were obtained by linking two UK studies: the UK Collaborative HIV Cohort (UK CHIC) study and the National Study of HIV in Pregnancy and Childhood (NSHPC). Treatment responses were assessed for 2028 women initiating ART at least one year after HIV-diagnosis. Outcomes were compared using logistic regression, proportional hazards regression or linear regression. Results In adjusted analyses, ART-naïve (n = 1937) and ZDVm-experienced (n = 91) women had similar increases in CD4 count and a similar proportion achieving virological suppression; both groups had a low risk of AIDS. Conclusions In this setting, antenatal ZDVm exposure did not adversely impact on outcomes once ART was initiated for the woman’s health.
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Affiliation(s)
- Susie Huntington
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Williams K, Huntington S, Shaw N, Conway S, Peckham D. 229 Prucalopride: a review of the first 12 months of use. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
OBJECTIVES The aims of the study were (1) to measure the distance required to travel, and the distance actually travelled, to HIV services by HIV-infected adults, and (2) to calculate the proportion of patients who travelled beyond local services and identify socio-demographic and clinical predictors of use of non-local services. METHODS The straight-line distance between a patient's residence and HIV services was determined for HIV-infected patients in England in 2007. 'Local services' were defined as the closest HIV service to a patient's residence and other services within an additional 5 km radius. Multivariable logistic regression was used to identify socio-demographic and clinical predictors of accessing non-local services. RESULTS In 2007, nearly 57 000 adults with diagnosed HIV infection accessed HIV services in England; 42% lived in the most deprived areas. Overall, 81% of patients lived within 5 km of a service, and 8.7% used their closest HIV service. The median distance to the closest HIV service was 2.5 km [interquartile range (IQR) 1.5-4.2 km] and the median actual distance travelled was 4.8 km (IQR 2.5-9.7 km). A quarter of patients used a 'non-local' service. Patients living in the least deprived areas were twice as likely to use non-local services as those living in the most deprived areas [adjusted odds ratio (AOR) 2.16; 95% confidence interval (CI) 1.98-2.37]. Other predictors for accessing non-local services included living in an urban area (AOR 0.77; 95% CI 0.69-0.85) and being diagnosed more than 12 months (AOR 1.48; 95% CI 1.38-1.59). CONCLUSION In England, 81% of HIV-infected patients live within 5 km of HIV services and a quarter of HIV-infected adults travel to non-local HIV services. Those living in deprived areas are less likely to travel to non-local services.
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Affiliation(s)
- S Huntington
- Health Protection Agency Centre for Infections, London, UK.
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Huntington S, Folch C, González V, Meroño M, Ncube F, Casabona J. [Prevalence of human immunodeficiency virus and hepatitis C virus, and associated factors among injecting drug users in Catalonia]. Enferm Infecc Microbiol Clin 2009; 28:236-8. [PMID: 19695744 DOI: 10.1016/j.eimc.2009.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 05/29/2009] [Accepted: 06/10/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objectives of this study were to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injection drug users (IDUs) and identify the sociodemographic and behavioral factors in this population associated with these infections. METHODS Cross-sectional study in IDUs recruited in Catalonia in 2006. RESULTS Ever-sharing syringes was associated with both HIV and HCV infection. Indirect sharing of injecting equipment and injecting cocaine as the main drug were factors associated with HCV infection, and the fact of having injected in prison was associated with HIV infection. CONCLUSION Identification of sociodemographic and behavioral factors associated with these infections can be of help when designing specific preventive interventions for IDUs.
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Affiliation(s)
- Susie Huntington
- Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya, Hospital Universitari Germans Trias i Pujol, Badalona, España
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Huntington S, Hope V, Hutchinson S, Goldberg D, Ncube F. Diversity of needle exchange provision in the UK: findings from a national survey. ACTA ACUST UNITED AC 2006; 11:E060810.4. [PMID: 16966779 DOI: 10.2807/esw.11.32.03022-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Needle exchanges are key to reducing transmission of bloodborne viruses (BBVs) in injecting drug users (IDUs) through the provision of sterile
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Affiliation(s)
- S Huntington
- Health Protection Agency Centre for Infections, London, United Kingdom.
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Gibson B, Huntington S, Rubanov S, Olivero P, Digweed-Lyytikäinen K, Canning J, Love J. Exposure and characterization of nano-structured hole arrays in tapered photonic crystal fibers using a combined FIB/SEM technique. Opt Express 2005; 13:9023-9028. [PMID: 19498937 DOI: 10.1364/opex.13.009023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents a technique to expose and characterize nano-structured hole arrays in tapered photonic crystal fibers. Hole array structures are examined with taper outer diameters ranging from 12.9 microm to 1.6 microm. A combined focused ion beam milling and scanning electron microscope system was used to expose and characterize the arrayed air-silica structures. Results from this combined technique are presented which resolve hole-to-hole pitch sizes and hole diameters in the order of 120 nm and 60 nm, respectively.
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Sidiroglou F, Huntington S, Roberts A, Baxter G. Micro-characterisation of erbium-doped fibers using a Raman confocal microscope. Opt Express 2005; 13:5506-5512. [PMID: 19498546 DOI: 10.1364/opex.13.005506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We demonstrate the application of a Fluorescence Intensity Confocal Optical Microscopy technique to the determination of the relative erbium ion distribution in optical fibers. As well as being able to acquire two dimensional profiles of the relative erbium ion distribution, this method can also provide valuable information on a sub-micron level regarding physical and optogeometric parameters of the examined samples.
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Canning J, Buckley E, Huntington S, Lyytikäinen K. Using multi-microchannel capillaries for determination of the zeta potential of a microfluidic channel. Electrochim Acta 2004. [DOI: 10.1016/j.electacta.2004.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lyytikainen K, Huntington S, Carter A, McNamara P, Fleming S, Abramczyk J, Kaplin I, Schötz G. Dopant diffusion during optical fibre drawing. Opt Express 2004; 12:972-977. [PMID: 19474911 DOI: 10.1364/opex.12.000972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diffusion of Ge and F was studied during drawing of silica optical fibres. Preforms were drawn using various draw conditions and fibres analysed using the etching and Atomic Force Microscope (AFM) technique. The results were confirmed by comparison with fibre Refractive Index Profiles (RIP). Both Ge and F were found to diffuse at high temperature, 2100 degrees C, and low draw speed, 10m/min. Diffusion simulations showed that most diffusion occurred in the neck-down region. The draw temperature and preform feed rate had a comparable effect on diffusion, whereas preform diameter did not significantly affect the diffusion.
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Huntington S, Lyytikainen K, Canning J. Analysis and removal of fracture damage during and subsequent to holey fiber cleaving. Opt Express 2003; 11:535-540. [PMID: 19461762 DOI: 10.1364/oe.11.000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The damage caused by cleaving holey fibers is investigated as a function of cleaving force. Comparisons are made with standard optical fibers and holey fibers. Optimum cleaving forces are determined for a number of holey fiber air fractions and fiber diameters. A simple technique for removing cleave damage is also presented.
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Huntington S, Katsifolis J, Gibson B, Canning J, Lyytikainen K, Zagari J, Cahill L, Love J. Retaining and characterising nano-structure within tapered air-silica structured optical fibers. Opt Express 2003; 11:98-104. [PMID: 19461711 DOI: 10.1364/oe.11.000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Air-silica fiber 125m in diameter has been tapered down to ~15m. At this diameter, it is commonly assumed that the nanostructured fiber holes have collapsed. Using an Atomic Force Microscope, we show this assumption to be in error, and demonstrate for the first time that structures several hundred nanometers in diameter are present, and that hole array structures are maintained. The use of Atomic Force Microscopy is shown to be an efficient way of characterising these structures.
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Huntington S. Provider terminations: strategies for risk management. Healthc Financ Manage 2000; 54:35-7. [PMID: 10847913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Managed care organizations should protect themselves from possible legal action by providers whom they have terminated, whether because of professional incompetence or for reasons related to the organization's business goals. Risk management begins by being aware of state and Federal laws regarding contracts, peer review, restraint of trade, discrimination, and retaliation against a provider. Managed care organizations should adopt a set of criteria for providers' professional competence as well as a list of business objectives that might necessitate the deselection of a provider. Because some courts have upheld a provider's right to a "fair procedure," managed care organizations also should consider offering providers an opportunity to respond to the termination decision.
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Affiliation(s)
- S Huntington
- Health Care Division, Chubb Executive Risk, Simsbury, Connecticut, USA
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Huntington S. Understanding managed care organizations' liability exposure. Healthc Financ Manage 1998; 52:41-2. [PMID: 10176447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Managed care organizations can minimize their liability exposures by staying informed about industry changes and by implementing a comprehensive risk management program. Typically, managed care organizations face three general exposure areas: directors and officers liability (e.g., exposures associated with nonclinical aspects of an organization); errors and omissions (e.g., exposures involving the day-to-day operations of managing the health care received by an organization's members); and financial loss, or provider excess (e.g., exposures that occur when certain catastrophic events expose the organization to financial peril).
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McCullough J, Steeper TA, Connelly DP, Jackson B, Huntington S, Scott EP. Platelet utilization in a university hospital. JAMA 1988; 259:2414-8. [PMID: 3352130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions.
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Affiliation(s)
- J McCullough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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Huntington S, Warnick JS. Pharmacists' attitudes toward PAs. Results of a Wisconsin study. Physician Assist 1987; 11:108, 110-1, 114. [PMID: 10314648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Eight months after physician assistants in Wisconsin were given the authority to write prescriptions, a survey of pharmacists in that state indicated that PAs were utilizing the privilege. The survey further concluded that the technical quality of prescriptions written by PAs was appropriate, that pharmacists have confidence in prescription writing by PAs, and that other professionals in health care and the public need to be informed about PA prescribing authority.
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Abstract
Peripheral blood lymphocytes are heterogeneous and can be divided into subpopulations based on cell surface markers. Lymphocytes from 101 normal individuals of all ages were tested for their ability to form spontaneous rosettes with sheep erythrocytes (T cells) and for surface immunoglobulins (B cells). Cord bloods of newborn infants and bloods from children (age 1-10 years) showed greater numbers of total lymphocytes, total T cells and unmarked cells than a control group of 50 individuals from age 11-60 years. In 22 normal elderly individuals (age 61-98 years), total lymphocytes and total T and B cells were not decreased. These data suggest that the depression of cellular immune response described in elderly populations may be related to a dysfunction in a segment of T cells or an aberration in the complex interaction among T cells, B cells and macrophages.
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